HPV and Me (and You)!

Back in August of 2013, one of WHF’s brave staff members, Lise Wood, wrote a blog about the HPV vaccine. Curious about the safety, side effects, and benefits of the vaccine for her daughter, Lise turned to the blog to shed some light on the situation and initiate a discussion with all of you. Her post was met with comments from many passionate mothers, doctors, and women itching to talk about sexual and pelvic health. As we all know, talking about the risks of sex can be an incredibly uncomfortable topic – especially when it comes to our own health and safety, or the well-being of our sisters, daughters, grand-daughters, nieces, and so on. Blogs, however, offer a great forum for this discussion – comments are welcome so that we may all educate each other a little bit more and perhaps bring forth a new perspective.

In an article published in the May 7th Chicago Tribune, HPV vaccines still face uphill battle¸ author Danielle Braff explains the stigmatization and underuse of the vaccine. The HPV vaccine, which was developed 8 years ago, has done exactly what it was supposed to do. A 2013 study published in The Journal of Infectious Diseases found a 56% decrease in the prevalence of the most common types of HPV among women aged 14-19 in the first four years after the vaccine was on the market. So, why, are young men and women not getting vaccinated? A staggering 67% of young women and 99% of young men are not getting the shot. I suppose it can be a hassle – the vaccination comes in a series of three shots over a six month period. According to the CDC, almost 1 in 4 girls who have started the vaccine series did not get all three shots – 53% have received the first shot while only 33% received all three doses. The numbers for boys are even more alarming; 8% received the first shot while only 1% received all three. Each year, about 21,000 of HPV-related cancers could be prevented by getting the HPV vaccine. So, I ask again, why are young men and women not getting vaccinated?

Well, I’ve got some ideas (some are mine, some that I’ve read). First, let me tell you a bit more about myself. I was just starting high school when the vaccination became available for girls. I remember when my first friend got the vaccine; I got home from school and asked my mom if it was something we should look into. She phoned our doctor on-call, my uncle, who told her to wait until we had a better idea of the safety, side effects, and benefits (a conversation we’re still having). I am lucky enough today, and was back then, to be able to talk to BOTH my parents candidly and honestly about sex and we concluded that I didn’t need it yet. However, once I was getting ready to start college, leaving my parents’ close grips, we figured it was time. There wasn’t much discussion with the doctor other than, “I’m here for an HPV shot” and “Ok, lift your shirt-sleeve.” Really, that’s all there was to the conversation. At the time, I didn’t know that the Gardasil shot only protects against the four most common strains of the Human Papilloma Virus. I also didn’t really care – I was experiencing the typical teenager, “It’ll never happen to me” phenomenon.

I recently graduated from Ohio University, and in my four years of college I worked as a health educator and wellness promoter, specifically focused on sexual health. I regularly went to dorms, classrooms, fraternities, and sororities with a penis model and a bag of male and female condoms, dental dams, and latex gloves in hand. During my sophomore year of college, my condom demonstrations began to sting with hypocrisy when I found out that I had a high risk strain of HPV. After some confused crying on the phone with my mom, I called my partner: “Yes, I got the shot!” “Why didn’t you tell me you had HPV?” “I thought you got tested!” It wasn’t until then that I learned there is no way for men to know if they have HPV. Pap smears check to see if abnormal cells are growing in your cervix not necessarily whether or not a woman has HPV. Only co-testing with an HPV test along with a pap can give you a direct answer.

After a year with HPV, a few uncomfortable biopsies and colposcopies, my body rid itself of the virus. Though I no longer have the virus, I have never stopped thinking about the vaccine. How worth it was it for me? The fact that the shot only covers the four most common strains has always bothered me. Two of these strains, 16 and 18, cause about 75% of cervical cancer cases, 70% of vaginal cancer cases, and up to 50% of vulvar cancer cases in females. The other two strains covered by the vaccine, 6 and 11, cause about 90% of genital warts cases in males and females. Sure, those numbers are high and the statistics are fantastic, but this shot can create a false sense of security. Referring to my own experience, I had no idea that the shot couldn’t make me completely HPV-worry-free. If young women and men don’t do their research, and their doctors and parents don’t tell them that they’re not completely protected, we can’t assume that they know. More importantly, we can’t assume that they know how to or that they know to protect themselves using barrier methods, like condoms.

Also, what many don’t realize is that, HPV can go far beyond the genitals. A person can also contract the virus in his or her mouth, anus, or penis. And, yes, this can result in anal, penal, head, neck, pharyngeal, and other cancers. I’m perusing Gardasil’s website and see no mention of these other types of cancer. Does the shot not protect against these cancers or is it not important to know about them? Well, I think it is important and I’d love to see some statistics about whether or not the shot can prevent things other than cervical, vaginal, and vulvar cancers.

So again, why aren’t people getting vaccinated? Like I said before, the typical teen “It’ll never happen to me” phenomenon exists – boy, does it. HPV is stigmatized because it can cause cancer or genital warts. That’s the ick factor. If young adults hear the words “genital warts” it is immediately greeted with an “ick.” Jason McDonald, a spokesman for the CDC’s National Center for Immunizations and Respiratory Diseases stated that “Almost every person who is sexually active will acquire HPV at some time in their life.” If teens are too uncomfortable to talk about the fact that they have HPV then other teens will never believe that they can get it. Hence, “It’ll never happen to me.” There are also regional differences. Southeastern states have the lowest rate of vaccination and also the highest rates of cervical cancer. If the people around you aren’t getting vaccinated and don’t see the purpose – would you?

Braff makes a fantastic point in her article – why isn’t the HPV vaccine grouped with every other vaccine children get? Pediatricians generally don’t see sex-related infections, and therefore the importance of starting an HPV vaccine series may not be a priority. However, by vaccinating before a child is sexually active, once kids mature they are already protected against the most common strains.

After my own experience, you might expect me to think negatively about the vaccine – and trust me, I have. But at the end of the day, I support it. The statistics are remarkable and the vaccine has very obvious benefits. Preventing genital warts and the various types of cancer caused by HPV doesn’t stop at a vaccine. The most important thing is communication. Parents and their kids should be able to communicate comfortably with their doctors about the vaccine, children with their parents about sex and preventing sexually transmitted infections, and educators should communicate with their classrooms in hopes of de-stigmatizing HPV. Without that, we can’t expect to see any real difference. What do you think?